Month: August 2017

A number of whistleblowers allege that a health and safety failure on the part of the Air Corps has caused their chronic illnesses. Joe Leogue looks at their case and how, just as with Garda Maurice McCabe, ‘coincidence after coincidence after coincidence’ has emerged to undermine their position.

“THERE are those who may say that this litany of grave errors can’t just simply be coincidence after coincidence after coincidence that is being suggested,” the senior counsel said.

The line was a standout contribution in a tribunal that made headlines in every news outlet this summer.

Senior counsel Pat Marrinan was talking about Garda Whistleblower Maurice McCabe — and how every one of a number of apparent ‘coincidences’ in his case worked to his detriment.

However, the line also resonated with whistleblowers involved in a different dispute.

A dispute that has found some at odds with the State. An ongoing scandal that has seen allegations of a cover-up, the alleged intimidation of those speaking out against the Defence Forces, and one that can be boiled down to one question: Are a number of men who served the State now seriously ill because of the Defence Forces’ failure to protect them from the effects of harmful chemicals?

Those speaking out do not believe the various occurrences — revealed in a series of articles in this newspaper since January — can be
coincidental.

The ongoing issue relating to chemical exposure in the Air Corps concerns two separate, yet related problems for the Defence Forces — the first of which was raised in 2013.

Back then, the first of a number of lawsuits against the State was filed in the High Court in which it was alleged that there were historic failures to protect technicians from the effects of the chemicals they used.

The second problem was revealed in November 2015, when the first of four whistleblowers within the Air Corps made protected disclosures to the then-defence minister Simon Coveney.

These men warned that the Air Corps was not doing enough to protect currently serving technicians from the harmful effects of the chemicals with which they clean and service the aircraft.

Their warnings would be vindicated following an independent investigation last year.

And yet the red flags should have been raised as far back as 2013, when the first of the lawsuits came — allegations that would be echoed years later by the protected disclosures.

An Air Corps official has rejected claims that inspection reports at the centre of legal cases against the State were deliberately destroyed, describing the allegations as malicious, writes Joe Leogue.

Air Corps tail wags ministerial dog.

The rebuke of the claims is contained in a series of emails between the Defence Forces and the Department of Defence, which has been seen by the Irish Examiner.

The State faces legal action from several former Air Corps technicians who claim the Defence Forces failed to adequately protect them from the harmful effects of the toxic chemicals they used on a daily basis.

Four whistleblowers have made protected disclosures on health and safety issues within the Air Corps — with two alleging that inspection reports show the Defence Forces were aware of safety shortcomings in the 1990s were deliberately destroyed as part of a cover-up.

However, Comdt Mark Donnelly, the Air Corps formation safety adviser, rejected these claims, and said the missing reports were “misplaced with the passage of time”.

“AC Formation and former Formation safety personnel have already commented on their concerns regarding these allegations,” Comdt Donnelly wrote in an email on March 8.

“These allegations of deliberate destruction of such documents are completely unfounded. It is my opinion that these comments are intended to be inflammatory, vexatious and malicious.”

Purpose of review

Isocyanates, reactive chemicals used to generate polyurethane, are a leading cause of occupational asthma worldwide. Workplace exposure is the best-recognized risk factor for disease development, but is challenging to monitor. Clinical diagnosis and differentiation of isocyanates as the cause of asthma can be difficult. The gold-standard test, specific inhalation challenge, is technically and economically demanding, and is thus only available in a few specialized centers in the world. With the increasing use of isocyanates, efficient laboratory tests for isocyanate asthma and exposure are urgently needed.

Recent findings

The review focuses on literature published in 2005 and 2006. Over 150 articles, identified by searching PubMed using keywords ‘diphenylmethane’, ‘toluene’ or ‘hexamethylene diisocyanate’, were screened for relevance to isocyanate asthma diagnostics. New advances in understanding isocyanate asthma pathogenesis are described, which help improve conventional radioallergosorbent and enzyme-linked immunosorbent assay approaches for measuring isocyanate-specific IgE and IgG. Newer immunoassays, based on cellular responses and discovery science readouts are also in development.

Summary

Contemporary laboratory tests that measure isocyanate-specific human IgE and IgG are of utility in diagnosing a subset of workers with isocyanate asthma, and may serve as a biomarker of exposure in a larger proportion of occupationally exposed workers.

***

Introduction

Diisocyanates (toluene diisocyanate, TDI; hexamethylene diisocyanate, HDI; and diphenylmethane diisocyanate, MDI) or functionally similar polymeric isocyanates are the obligate cross-linking agent for the commercial production of polyurethane, a polymer upon which modern society has become dependent. Millions of tons of isocyanate are produced and consumed annually throughout the world in a wide variety of end-use work environments [1,2–5,6•,7•]. Workplace exposure remains the best-recognized risk factor for isocyanate asthma, but is complicated to quantitate, involving mixtures of isomers and ‘prepolymers’ diluted in solvents, in aerosol and vapor phases. In certain occupational settings, exposure can cause isocyanate asthma and long-lasting bronchial hyperreactivity [1,8,9,10•,11•]. Early recognition of isocyanate asthma and prompt removal from isocyanate exposure improves the long-term prognosis for sensitive individuals [9]. There thus exists the need for practical screening/diagnostic tests for isocyanate asthma as well as tests that can monitor personal exposure.

The clinical presentation of isocyanate asthma is strikingly similar to common environmental asthma, prompting the hypothesis that the disease has an immunological basis, although subtle differences have been noted [9,10•,12•]. Animal models support this hypothesis, and are beginning to dissect the potential role of individual genes with transgenic strains [13••,14••,15,16••,17,18]. Allergists and immunologists have overcome substantial challenges working with reactive isocyanates to develop serology assays for isocyanate-specific antibodies [19–21]. Such assays have provided evidence to support allergic asthma to isocyanate in a small percentage of workers, but cannot detect isocyanate-specific IgE in the majority of sensitive individuals. These results have left great uncertainty in the field. Does isocyanate asthma involve mechanisms of pathogenesis (e.g. non-IgE) distinct from those in common atopic asthma or are specific IgE antibodies present, but our detection assay for them is flawed? Are we using the wrong antigenic form of isocyanate in our serology tests, or testing workers at the wrong time (after removal from exposure)? Does isocyanate asthma, as presently defined, possibly represent a spectrum of diseases, which only in some cases is associated with an antibody response [3,9,10•]?

The present review summarizes the rationale and use of clinical laboratory tests for immune responses that reflect isocyanate exposure and asthma, with emphasis on data generated within the past year. The potential utility of ‘isocyanate-specific’ serum IgE and IgG as biomarkers and the isocyanate antigen recognized by these immunoglobulins are described [22••,23]. Clinical usage and limits of contemporary assays for isocyanate asthma and exposure are discussed along with promising future assays [20,24,25••].

The Irish Army Air Corps has dismissed a number of previously fit personnel as suffering from asthma. It has never carried out a health study of personnel exposed long term and without protection to Isocyanates and has never carried out adequate risk specific health surveillance. Neither has the Air Corps ever carried out risk specific health surveillance for personnel who suffered long term exposure to jet fuel & jet exhaust gasses.

Bizarrely serving and former Air Corps personnel have been “reassured” by Air Corps medical personnel that their asthma does not have a workplace related cause despite no evidence of any testing for them to form a conclusion either way.

Considering what is now known about the extremely poor chemical health & safety environment in the Irish Air Corps any doctor, dismissing without appropriate testing, any possibility of a workplace casual link is surely opening himself or herself up to accusations of professional misconduct.

The tiniest trickle of blood

My father was an aircraft technician in the Air Corps at Casement Aerodrome in Baldonnel for 21 years. During his time there he worked on a variety of aircraft and worked with an assortment of chemicals and sprays often without, as he said himself, even glove protection.

Over that time he developed severe psoriasis on his body, but in particular his hands and legs. This resulted in intense itch and pain and a daily routine of medication and treatment of the various lesions on his legs and also a stay in St. Bricin’s Hospital. It was not until a combination of appointments with a renowned Traditional Medical Herbalist, coupled with his retirement from the Air Corps that improvements began. This psoriasis, while appearing at a much slighter level during his life, never appeared to the same extent after leaving Baldonnel.

My mother passed away in 2009, and since then Dad lived with my wife and I, and subsequently, our two daughters. He adored his family and his granddaughters. He also really enjoyed an active and healthy life, learning to swim, regularly walking, going dancing, and eating very healthily. He liked his few social pints but gave up smoking before his first granddaughter was born eight years ago. He also had regular full check-ups with his GP.

In December 2013, while Dad was feeling very well, in great form, he spotted the tiniest trickle of blood in his urine. After attending his GP and a urologist, it was confirmed that he had renal cancer, which had completely taken over one of his kidneys and indeed had also spread to his lungs. Treatment was possible but immediate: he would need to have his kidney removed and a tablet form of chemotherapy would need to be taken for the rest of his life. Thankfully medical advances had developed this treatment, otherwise he would not have survived.

Almost two years passed and Dad had little or no side-effects to his treatment other than his dark hair turning grey overnight. He maintained his life as it was, keeping up his hobbies and his active lifestyle, as well as continuing his breaks to Lanzarote. Unfortunately in November 2015, things began to change and his body rejected the tablet. He became very ill with a litany of mystery illnesses that befuddled doctors but, miraculously, he managed to survive and came home. However, he spent his New Year’s Day in A&E, complaining of intense pain in his back. On examination and scanning, it was found that he had a broken vertebrae due to cancer spreading to his back. Again, thankfully it was in the position that it was, as it was treatable and would not end up with him in a wheelchair. Inserting rods either side of his spine meant that he would walk again.

The last months of his life were a mix of regular check-ups, consultant appointments, progress and setbacks. It was a roller-coaster of emotions where his unyielding positivity was tested repeatedly but never left him.

It would have been interesting to see if his background in Baldonnel could have informed his treatment, or if indeed anything could have been done to prevent his disease. However such thoughts are merely conjecture and would distract from the magnificent memories we hold of a man who touched so many hearts and leaves behind a legacy fitting for such a character.